Operate, actions
Actions
Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.
Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed
Actions
26,640 derived from the last resolution run
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-014095 | Outreach suppressed pending steward Outreach | TPA-58463 (Jacob Espinoza) held until CASE-000651 is decided |
| Held | — | ||
| ACT-014096 | Outreach suppressed pending steward Outreach | ENR-122608 (Joe Graham) held until CASE-000652 is decided |
| Held | — | ||
| ACT-014097 | Outreach suppressed pending steward Outreach | CLM-417171 (Joe Graham) held until CASE-000653 is decided |
| Held | — | ||
| ACT-014098 | Outreach suppressed pending steward Outreach | TPA-57284 (Deborah Price) held until CASE-000654 is decided |
| Held | — | ||
| ACT-014099 | Outreach suppressed pending steward Outreach | ENR-139265 (Ann Davis) held until CASE-000655 is decided |
| Held | — | ||
| ACT-014100 | Outreach suppressed pending steward Outreach | CLM-429956 (Ann Davis) held until CASE-000656 is decided |
| Held | — | ||
| ACT-014101 | Outreach suppressed pending steward Outreach | TPA-57369 (Jsoeph Stephens) held until CASE-000657 is decided |
| Held | — | ||
| ACT-014102 | Outreach suppressed pending steward Outreach | ENR-121978 (Joseph Stephens) held until CASE-000658 is decided |
| Held | — | ||
| ACT-014103 | Outreach suppressed pending steward Outreach | TPA-57338 (Kevin Harvey) held until CASE-000659 is decided |
| Held | — | ||
| ACT-014104 | Outreach suppressed pending steward Outreach | TPA-52423 (Theresa Harvey) held until CASE-000660 is decided |
| Held | — | ||
| ACT-014105 | Outreach suppressed pending steward Outreach | TPA-60417 (Mason Vasquez) held until CASE-000661 is decided |
| Held | — | ||
| ACT-014106 | Outreach suppressed pending steward Outreach | CLM-400439 (Juan Castro) held until CASE-000662 is decided |
| Held | — | ||
| ACT-014107 | Outreach suppressed pending steward Outreach | CLM-430329 (Ashley Hunter) held until CASE-000663 is decided |
| Held | — | ||
| ACT-014108 | Outreach suppressed pending steward Outreach | CLM-415561 (Olivia Perez) held until CASE-000664 is decided |
| Held | — | ||
| ACT-014109 | Outreach suppressed pending steward Outreach | PRV-27753 (Cheryl Perz) held until CASE-000665 is decided |
| Held | — | ||
| ACT-014110 | Outreach suppressed pending steward Outreach | CLM-424067 (Patricia Russ) held until CASE-000666 is decided |
| Held | — | ||
| ACT-014111 | Outreach suppressed pending steward Outreach | CLM-408534 (Billy Rice) held until CASE-000667 is decided |
| Held | — | ||
| ACT-014112 | Outreach suppressed pending steward Outreach | TPA-53751 (Billy Rice) held until CASE-000668 is decided |
| Held | — | ||
| ACT-014113 | Outreach suppressed pending steward Outreach | TPA-60875 (Helen Welch) held until CASE-000669 is decided |
| Held | — | ||
| ACT-014114 | Outreach suppressed pending steward Outreach | TPA-59630 (Sandra Stevens) held until CASE-000670 is decided |
| Held | — | ||
| ACT-014115 | Outreach suppressed pending steward Outreach | CLM-410190 (Gabriel Ward) held until CASE-000671 is decided |
| Held | — | ||
| ACT-014116 | Outreach suppressed pending steward Outreach | PRV-22957 (Gabriel Ward) held until CASE-000672 is decided |
| Held | — | ||
| ACT-014117 | Outreach suppressed pending steward Outreach | CLM-427063 (Angela Ellis) held until CASE-000673 is decided |
| Held | — | ||
| ACT-014118 | Outreach suppressed pending steward Outreach | TPA-50787 (Diane Lopez) held until CASE-000674 is decided |
| Held | — | ||
| ACT-014119 | Outreach suppressed pending steward Outreach | CLM-412231 (Jennifer Le) held until CASE-000675 is decided |
| Held | — | ||
| ACT-014120 | Outreach suppressed pending steward Outreach | TPA-55388 (Jennifer Le) held until CASE-000676 is decided |
| Held | — | ||
| ACT-014121 | Outreach suppressed pending steward Outreach | CLM-419599 (Carolyn Gordon) held until CASE-000677 is decided |
| Held | — | ||
| ACT-014122 | Outreach suppressed pending steward Outreach | CLM-410862 (Rachel Porter) held until CASE-000678 is decided |
| Held | — | ||
| ACT-014123 | Outreach suppressed pending steward Outreach | TPA-56091 (Katherine Porter) held until CASE-000679 is decided |
| Held | — | ||
| ACT-014124 | Outreach suppressed pending steward Outreach | CLM-428591 (Kayla Vazquez) held until CASE-000680 is decided |
| Held | — | ||
| ACT-014125 | Outreach suppressed pending steward Outreach | PRV-28311 (Deborah Bishop) held until CASE-000681 is decided |
| Held | — | ||
| ACT-014126 | Outreach suppressed pending steward Outreach | ENR-137167 (Deborah Bisshop) held until CASE-000682 is decided |
| Held | — | ||
| ACT-014127 | Outreach suppressed pending steward Outreach | CLM-412237 (Yuki Boyd) held until CASE-000683 is decided |
| Held | — | ||
| ACT-014128 | Outreach suppressed pending steward Outreach | CLM-418766 (Tyler Vargas) held until CASE-000684 is decided |
| Held | — | ||
| ACT-014129 | Outreach suppressed pending steward Outreach | CLM-432821 (Margaret Patel) held until CASE-000685 is decided |
| Held | — | ||
| ACT-014130 | Outreach suppressed pending steward Outreach | TPA-51942 (Sandra Porter) held until CASE-000686 is decided |
| Held | — | ||
| ACT-014131 | Outreach suppressed pending steward Outreach | TPA-53792 (Lori Dominguez) held until CASE-000687 is decided |
| Held | — | ||
| ACT-014132 | Outreach suppressed pending steward Outreach | ENR-100679 (Judith Ortiz) held until CASE-000688 is decided |
| Held | — | ||
| ACT-014133 | Outreach suppressed pending steward Outreach | CLM-410712 (Mason Carter) held until CASE-000689 is decided |
| Held | — | ||
| ACT-014134 | Outreach suppressed pending steward Outreach | CLM-415176 (Andrew Snyder) held until CASE-000690 is decided |
| Held | — | ||
| ACT-014135 | Outreach suppressed pending steward Outreach | ENR-119996 (Andy Snyder) held until CASE-000691 is decided |
| Held | — | ||
| ACT-014136 | Outreach suppressed pending steward Outreach | PRV-28096 (Tyler Sanders) held until CASE-000692 is decided |
| Held | — | ||
| ACT-014137 | Outreach suppressed pending steward Outreach | CLM-431383 (Stephen Mason) held until CASE-000693 is decided |
| Held | — | ||
| ACT-014138 | Outreach suppressed pending steward Outreach | ENR-131444 (Niccole Mason) held until CASE-000694 is decided |
| Held | — | ||
| ACT-014139 | Outreach suppressed pending steward Outreach | CLM-424051 (Nicole Mason) held until CASE-000695 is decided |
| Held | — | ||
| ACT-014140 | Outreach suppressed pending steward Outreach | ENR-115067 (Marcus Armstrong) held until CASE-000696 is decided |
| Held | — | ||
| ACT-014141 | Outreach suppressed pending steward Outreach | CLM-411451 (Marcus Armstrong) held until CASE-000697 is decided |
| Held | — | ||
| ACT-014142 | Outreach suppressed pending steward Outreach | TPA-56573 (Omar Obrien) held until CASE-000698 is decided |
| Held | — | ||
| ACT-014143 | Outreach suppressed pending steward Outreach | ENR-119611 (Omar Obrien) held until CASE-000699 is decided |
| Held | — | ||
| ACT-014144 | Outreach suppressed pending steward Outreach | CLM-401562 (Omar Obrien) held until CASE-000700 is decided |
| Held | — |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.